Got pain? you’re not alone
Acute and chronic pain affects approximately 100 million Americans, with the annual costs associated with chronic pain is estimated to be $560-635 billion.
Pain is a uniquely individual and subjective experience that depends on a variety of biological, psychological, and social factors.
For many patients, the treatment of pain is inadequate not just because of uncertain diagnoses and societal stigma, but also because of shortcomings in the availability of effective treatments and inadequate patient and clinician knowledge about the best ways to manage pain.
(Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011.)
There are three Phases of pain
Immediate pain is generally caused by irritation to pain fibers called nociceptors. Examples include a burn, prick or bite. We reflexively attempt to withdraw from the nociceptive irritant and thus this type of pain is usually self-limiting and short-lived.
If the stimulus causing immediate pain is strong enough, or the irritation is prolonged, acute pain ensues. This type of pain is known as inflammation and is characterized by:
Acute pain is also generally self-limiting, depending upon whether there is ongoing nociceptive irritation, such as overuse or in the case of an injury, continued irritation though aggravating activities.
Inflammation is a GOOD thing. Your body goes through this process in order to heal the injury. Ice, immobilization and NSAIDs all impede the healing process, with the end result being chronic pain.
Chronic pain can be due to:
- Ongoing nociception or inflammation
- Psychological factors
- Neuropathic pain- Structural and functional changes in soft tissues, joints and the nervous system
At this point, you know more about pain than most General Practitioners and Allied Health Care providers.
Got pain- What should you do?
Remove the offending agent or irritant.
Help the body through the process. This can be achieved through a number of means:
Mobilization to encourage circulation
Exercise to help maintain normal range of motion and avoid developing adhesions
Analgesics to reduce pain, e.g. topical counter irritants
Treatment- e.g. Voodoo flossing (see prior blogs), acupuncture and fascial massage
Alternating hot and cold applications
Heat- 3 min
Cold- 1 min
Alternate THREE times
Many supplements work on similar pathways as NSAIDs. These pathways are responsible for the pain and healing effects of the inflammatory process.
Whereas NSAIDs block pathways, there are a number of supplements that balance pro and anti inflammatory eicosanoids, resulting in a reduction in pain while at the same time promoting healing.
Some supplements include:
- Vitamin C and Bioflavonoids
- Fish oil
If chronic pain is due to an underlying ongoing inflammatory process, such as an autoimmune disease, then lifestyle factors need to be addressed (e.g. sleep, environmental exposure to toxins, diet).
Chronic pain due to psychological factors can be related to repressed emotions such as anger. This activates the autonomic nervous system, resulting in sympathetic dominance and Tension Myositis Syndrome (TMS).
John Sarno’s book on the Mind Body Connection is a great resource for TMS.
Neuropathic pain involves:
- The Nervous system
- The Muscular system
- The Skeletal system
The nervous system is responsible for force-couple relationships (synergistic movements
between muscle groups).
The muscular system includes soft tissues (i.e. muscles, tendons, fascia) and functions efficiently when length-tension relationships between the muscles are optimal.
The skeletal system is comprised of joints. It is the interconnection of bones from the feet up to the skull.
In chronic pain there is imbalance between these systems that is characterized by dysfunctional:
- Length-tension relationships of soft tissues
- Force-couple relationships (movement patterns)
- Arthrokinematics (Joint function)
The end result is a perpetual pain-injury cycle:
Neuropathic pain management involves:
- Restoring optimum length and tension to soft tissues through manual therapies
- Joint mobilization/Manipulation
- Corrective exercises to support treatment and create new motor patterns
Got Pain? If so, now you know how to identify the phase and appropriate treatment plan